Permit CITY OF TIGARD PLUMBING PERMIT
4.,.,�,,�., DEVELOPMENT SERVICES PERMIT # • PLM97 —013E
;-! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 04/23/97
PARCEL: 2SI03BA -00137
SITE ADDRESS...: 11920 SW LYNN ST
SUBDIVISION • LERON HEIGHTS NO. 2 ZONING: R -4.5
BLOCK . LOT •27 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:R3 FLOOR DRAINS : 0 TRAPS • 0
STORIES • 0 WATER HEATERS 0 CATCH BASINS : 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0
SINKS • 0 URINALS • 0 GREASE TRAPS : 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 100
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Run sewer line for SWR97 -0126.
Owner: FEES
JACK PERCY AND KATHERINE PERCY type amount by date recpt
11920 SW LYNN PRMT $ 30.00 JSD 04/23/97 97- 293620
TIGARD OR 97223 5PCT $ 1.50 JSD 04/23/97 97- 293620
Phone #: 590 -4185
Contractor
OWNER
Phone #: $ 31.50 TOTAL
Reg #.. : 99999
REDUIRED INSPECTIONS
This pereit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This pereit will expire if work is not started
within 180 days of issuance, or if work is suspended for lore
than 180 days.
Permittee Signat'
Issued Byo4—
Call for inspection — 639 -4175
:ITY C 'tIGARD Plumbing Application Recd By
3 1 25 S HALL BLVD. Commercial and Residential Date Recd D z`3
E.
`CARD, OR 97223 Date to P
_03) 6394171
Date to DST
Permit s `i-wt 5?- 0) 3 ‘
Print or Type Related SWR s
Incomplete or illegible applications will not be accepted Called
Name of Development/Protect FIXTURES (individual) QTY PRICE AMT
Job .0.4 tier hie-Ok p (p/u.inbt Sink 9.00
Address Street Address // Suite
1 19 0 niki L7 n n S17 e _
9.00
rub or TuDrShower Comb. 9.00
Bug s C.tyiS ate Zip Shower Only 9.00
7 axd O Je 97�_ . Water Closet - 9.00
Name r, y y 9 ("�
�JOLC Sf rner n� 1 .. -FC..1 o:shwasner 9.00
y Owner Mailing Address 1 Suite J Garbage Disposal 9.00
1)97_0 SW Ly nn 5 Washing Machine
9.00
City/State , Phone Floor Drain 2' 9.00
Of-
a.o
T7 -3 599x/85 3 -
9.00
N
_ 4- 9.00
Occupant Mailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal
- 9.00
Name Other Fixtures (Specify) 9.00
:ontractor Mailing Address 9.00
Suite 9.00
-or to issuance City/State Zip Phone 9.00
3cplicant must 9.00
provide all Oregon Const. Cont. Board Lic.s Exp. Date 9.00
contractors
9.00
license Plumbing Lic. s Exp. Date K Sewer - 1st 100' �D i 3 0.00
information ...---4
for COT COT Business Tax or Metro S Exp. Date X Sewer -each additional 100' 25.00
database). Water Service - 1st 100' 30.00 -
Name Water Service - each additional 200' 25.00
A rchitect Storm g Rain Drain - tst 100' 30.00
or Mailing Address I Suite Storm 8 Rain Drain -each additional 100' 25.00
Mobile Home Space 25.00
Engineer City/State Zip I Phone Commercial Back Flow Prevention Device or Anti- 25
Pollution Device
_ -ts :abe .vorx New 0 Addition O Alteration O Repair O Residential BaUt °ow Prevention Device' 15.00
cc done: Residential 0 Non - residential J Any Trap or Waste Not Connected to a Fixture
.Acc ":oval descriotion of wcrx ct I 9.00 •
Catch Basin 9.00
• insp. of Existing i-.umoing I 40.00
•
I
Specially Requested 40.00
s::rg use of y equested Inspections 40.00 j
'.ding or property I I 000.00
Rain Drain, single ` amity dwelling I I 30.
:dosed use of Grease Traps I 9.00
:icing or property
QUANTITY TOTAL I
. cu caooing . moving or replacing any fixtures? Yes _ No ] Isorretnc cc nser di agram's recurred 1 Cuanity is > B
: r yes see back of forme • 'SUBTOTAL
e: eoy acknowledge that I have read ;his application, that Me information et
:- is correct. that I am :-:e owner or authorized agent of the owner. and 5% SURCHARGE I / 5V.
it clans submitted are it compliance with Oregon State Laws.
S ignature of Owner /Agent I Date PLAN REVIEW 25% OF SUBTOTAL I
Date,
�7 Recuued m y i Srmre cri al 3 . >
4 �
- ` / ?L19 / TOTAL
2.:nact Person Name Phone I 7/ S
�� f�
'Minimum permit fee is 525 • 5% surcharge. except Residential Backflow
_
V. i l &r 'e l L -/ � 590 -Li 185 Prevention Device. wric. is S15 • 5 % surcharge
J i :'Asts'.plmapp.doc 3'96
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
j Fixtures to be capped, moved or replaced I Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
:OMMENTS REGARDING ABOVE:
•